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Biomedical subjects

E H Hwang

Publications and source records attributed to E H Hwang.

At least 37 records · Page 2Linked to original sources
PubMed1999

[99mTc-GSA dynamic SPECT for regional hepatic functional reserve estimation: assessment of quantification].

For the estimation of regional hepatic functional reserve, we produced a three-dimensional hepatic functional mapping method employing 99mTc-GSA dynamic SPECT. In this analyzing protocol, we applied Patlak plot for the estimation of the liver uptake parameter of GSA, which is named hepatic GSA clearance, because it is relatively simple and suitable for matrix by matrix analysis. In this study, we assessed the physiological implication of estimated parameters and the clinical value of this analyzing method for hepatic functional reserve estimation. After venous injection of 185 MBq of GSA (3 mg), fifteen sequential sets of SPECT data were acquired for 15 minutes. First 5 sets (minutes) SPECT images were analyzed by Patlak plot and hepatic GSA clearance (ml/min) was obtained in each matrix. The sum of hepatic GSA clearance in each matrix (total hepatic GSA clearance) was calculated as an index of whole liver functional reserve. Total hepatic GSA clearance was compared with receptor index or effective blood flow (EHBF) of whole liver which were analyzed by Direct Integral Linear Least Square Regression (DILS) method for the assessment of the physiological implications of hepatic GSA clearance. The clinical value of total hepatic GSA clearance was assessed in comparisons with the conventional hepatic function test. A very good correlations were observed between total hepatic GSA clearance and receptor index (r = 0.935, p < 0.0001, n = 49), whereas the correlations between total hepatic GSA clearance and EHBF were not significant. Significant correlations were also observed between total hepatic GSA clearance and the conventional hepatic function tests, such as choline esterase (r = 0.517, p = 0.0001, n = 47), albumin (r = 0.612, p < 0.0001, n = 49), hepaplastin test (r = 0.539, p < 0.0001, n = 47), ICG R15 (r = -0.616, p < 0.0001, n = 37). These results suggested that hepatic GSA clearance strongly reflects hepatic receptor function and this parameter seemed to be useful for the hepatic functional reserve estimation.

Chronic Disease↗
PubMed1999

[99mTc-GSA dynamic SPECT for regional hepatic functional reserve estimation: assessment of clinical value for hepatic resection].

We assessed the clinical value of three-dimensional functional mapping method employing GSA dynamic SPECT for the estimation of residual hepatic functional reserve before hepatic resection. Seventy-two consecutive patients of liver tumor were recruited in this study. Thirty-seven underwent segmentectomy or lobectomy and 35 did subsegmentectomy. GSA studies were carried out in all 72 patients before operation. Postoperative studies were performed in 70 patients about 1 month after operation, and 2 patients died of postoperative hepatic failure early after operation. In the preoperative study, liver functional images were divided into 4 segments according to liver anatomy and segmental GSA clearance was analyzed. The sum of GSA clearance of the segments immune from resection were calculated as predicted residual GSA clearance. Two patients who showed poor predicted residual hepatic GSA clearance died of postoperative hepatic failure within two months after operation (extended right lobectomy). There were good correlations between pre- and postoperative total liver clearance in patients underwent subsegmentectomy (r = 0.900, p < 0.0001, n = 35), and between predicted residual clearance and postoperative total clearance in patients underwent segmentectomy or lobectomy (r = 0.799, p < 0.0001, n = 35). After hepatic resection, there seemed to be discrepancies between hepatic volume expansion and functional restoration in some patients. Mean GSA clearance (clearance per unit volume) apparently decreased after operation in patients whose residual volume ratio (preoperative predicted residual liver volume/preoperative total liver volume) were less than 50% (p < 0.01, n = 12). These results suggested that three-dimensional functional mapping method employing GSA dynamic SPECT can provide quantitative information of postoperative hepatic function and reserve before hepatic resection. Changes of mean GSA clearance after hepatic resection suggested that hepatic function per unit volume changes in the process of hepatic regeneration.

Chronic Disease↗
PubMed1999

Preoperative assessment of residual hepatic functional reserve using 99mTc-DTPA-galactosyl-human serum albumin dynamic SPECT.

UNLABELLED: Preoperative assessment of residual hepatic functional reserve offers important strategic information for hepatic resection. To predict the postoperative residual liver function, we assessed the value of hepatic 99mTc-diethylenetriamine pentaacetic acid-galactosyl-human serum albumin (99mTc-GSA) clearance estimated by dynamic SPECT analysis. METHODS: We investigated 114 consecutive patients with liver disease, including 55 hepatectomy cases. One minute after injection of 185 MBq 99mTc-GSA, 15 serial dynamic SPECT images were obtained every minute. The initial five sets of SPECT images were analyzed by Patlak plot to estimate the sequential initial hepatic 99mTc-GSA clearance (mL/min) as an index of hepatic function. The sum of hepatic 99mTc-GSA clearance of the segments immune from resection was categorized as predicted residual 99mTC-GSA clearance. In the hepatectomy cases, scintigraphy was performed before and 37 +/- 10 d after the operation. RESULTS: Good correlation was observed between the total hepatic 99mTc-GSA clearance and conventional hepatic function tests: plasma retention rate of iodocyanine green (ICG) at 15 min (ICG R15), r = -0.600, P < 0.0001, n = 94; plasma disappearance rate of ICG (K ICG), r = 0.670, P < 0.0001, n = 83; cholinesterase, r = 0.539, P < 0.0001, n = 121; serum albumin, r = 0.421, P = 0.0001, n = 123; and hepaplastin test, r = 0.456, P < 0.0001, n = 120. There was good correlation between the predicted residual 99mTc-GSA clearance and the postoperative total hepatic 99mTc-GSA clearance in patients who underwent segmentectomy or lobectomy (r = 0.84, P < 0.0001, n = 28) and between the pre- and postoperative total hepatic 99mTc-GSA clearance in patients who underwent subsegmentectomy (r = 0.91, P < 0.0001, n = 25). Five patients who had postoperative complications due to hepatic insufficiency (2 patients died of postoperative hepatic failure within 2 mo after operation) showed significantly lower predicted residual 99mTc-GSA clearance compared with the patients without complications (90.3 +/- 37.2 versus 320.9 +/- 158.8 mL/min; P < 0.005). CONCLUSION: The total hepatic 99mTC-GSA clearance reflected hepatic function. In addition, preoperative predicted residual hepatic 99mTc-GSA clearance was a good indicator of postoperative hepatic function and early prognosis. 99mTc-GSA dynamic SPECT is assumed to be a useful method for determining the surgical strategy in patients with hepatic tumor and especially in patients with hepatic dysfunction.

Coloring Agents↗
PubMed1998

Colon perforation in hyperimmunoglobulin E syndrome.

Colon perforation from hyperimmunoglobulin E syndrome is very rare, and only one case has been reported in the English-language literature. Herein, the authors report another case of colon perforation experienced in hyperimmunoglobulin E syndrome. The patient was an 8-year-old girl with frequent infection, eczematoid dermatitis, and an increased serum level of immunoglobulin E. During admission, panperitonitis developed caused by colon perforation. Treatment was resection of the perforated segment of the colon and a double-barrel colostomy. The patient has been doing well 18 months after treatment.

Child↗
PubMed1998

Absent myocardial iodine-123-BMIPP uptake and platelet/monocyte CD36 deficiency.

UNLABELLED: Global absence of myocardial 123I-15-(p-iodophenyl)-3-(R,S)-methyl pentadecanoic acid (BMIPP) uptake is occasionally noted, and it reflects myocardial long-chain fatty acid uptake abnormality. CD36, a membrane glycoprotein expressed on platelet, monocyte and endothelial cells, may contribute to myocardial fatty acid transport, and its deficiency has been reported in a small subset of the population. We hypothesized that CD36 deficiency may be related to absent myocardial BMIPP uptake. Thus, we investigated CD36 expression of platelet/monocyte in patients with absent myocardial BMIPP uptake. METHODS: Peripheral blood of 7 patients with global absence of myocardial BMIPP uptake (3 of 7 patients in one family) and 3 control subjects were examined in flow cytometric analysis. Platelet/monocyte surface CD36 was detected by using OKM5, an anti-CD36 mouse monoclonal antibody. RESULTS: There were no apparent relationships between specific clinical symptoms and absent myocardial BMIPP uptake. None of the blood samples of the 7 patients were stained with OKM5 on the platelet/monocyte cell surface, indicating that all of these patients were Type I CD36-deficient subjects. In contrast, all the control subjects showed normal staining. CONCLUSION: The fact that rare Type I CD36 deficiency was observed in all patients with absent myocardial BMIPP uptake suggests that CD36 plays a role in the myocardial long-chain fatty acid uptake process in humans.

Adult↗
PubMed1997

Actual half-life of alpha-fetoprotein as a prognostic tool in pediatric malignant tumors.

In a retrospective study, the prognostic value of monitoring the decay of alpha-fetoprotein (AFP) was assessed. Serum AFP was determined serially in 18 children with malignant germ-cell or hepatic tumors: 7 endodermal sinus tumor, 3 embryonal carcinoma, 5 malignant teratoma, 2 hepatoblastomas, and 1 hepatocellular carcinoma. The actual half-life (AHL) of AFP was computed after surgical resection of the tumor. In group 1, which had complete resection and no recurrence during follow-up (n = 13), the AHL of AFP was 4.0 +/- 0.9 days. In group 2, which had incomplete resection or recurrence during follow-up (n = 5), the AHL of AFP was 24.8 +/- 20 days, significantly longer than that of group 1 (P = 0.0026). The increased AHL of AFP indicated residual active tumor after surgical resection. The AHL of AFP may be more sensitive than serial monitoring of AFP in detecting preclinical recurrence after surgical resection of AFP-secreting tumors. Treatment strategies can be based on AFP clearance, and prospective clinical trials are warranted.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Functional imaging of gated Tc-99m tetrofosmin study as a simple method to quantify ventricular wall motion.

Myocardial perfusion scintigraphy with wall motion analysis is known to enhance accuracy in diagnosing ischemic heart disease. The purpose of this study is to determine the best method to evaluate regional wall motion in a gated planar perfusion study. Planar gated 99mTc tetrofosmin (GTF) study in two projections was performed after rest-exercise sequence SPECT studies (n = 29). To evaluate wall motion, cine-mode display, wall thickening, and inverted tetrofosmin studies including ventricular inner border tracing, segmental wall shortening and functional images were used. The results were compared with gated blood-pool (GBP) study in the same projections. In the GTF study, functional image identified asynergy significantly better than cinematic display. The best correlation between GTF and GBP studies was observed with functional images of phase and amplitude, with complete visual agreement seen in 145 of 168 (86%) segments. With quantitative analysis by means of regions of interest (n = 280), a good correlation was observed between GTF and GBP regarding regional amplitude (r = 0.78), regional phase (r = 0.84), average left ventricular phase (r = 0.91) and standard deviation of phase values (r = 0.90). The value for the count-based "ejection fraction" derived from inverted GTF showed insufficient correlation to that of the GBP study (r = 0.69). Functional imaging with myocardial perfusion imaging is a simple and effective means to evaluate ventricular asynergy. Similar diagnostic criteria to gated blood-pool imaging and comparable diagnostic accuracy are advantages of this approach.

Aged↗
PubMed1997

Acquired choledochal cyst from anomalous pancreatobiliary duct union.

The high incidence of anomalous pancreatobiliary duct union (APBDU) in children who have a choledochal cyst has been well documented. Additionally, cylindrical dilatation of the bile duct has been reproduced in animal models by anastomosing the pancreatic duct to the bile duct. In recent years, APBDU has been considered a possible etiologic factor in the formation of a choledochal cyst. The authors observed a progressive cylindrical dilatation of the common bile duct in a 6-year-old boy over an 18-month period. An operative cholangiogram showed a type Ic choledochal cyst and a type B APBDU (Todani classification). This clinical experience suggests that a normal common bile duct in children can be progressively dilated and become an acquired choledochal cyst arising as a complication of the preexisting APBDU.

Bile Ducts↗
PubMed1996

Absent myocardial I-123 BMIPP uptake in a family.

A 72-year-old woman with hypertension showed no sign of myocardial accumulation of 123I-BMIPP, and 201Tl and 123I-MIBG scintigraphy demonstrated normal findings. Electrocardiography showed left axis deviation with inverted T waves in leads I, aVL, V2-6 and QT prolongation. Coronary arteriography, two dimensional echo cardiography and laboratory data showed no abnormality. Her 66-year-old sister with non-insulin-dependent diabetes mellitus also had no myocardial BMIPP uptake, but had normal 201Tl finding. ECG and chest film findings were normal. Laboratory data indicated slightly high fasted blood glucose, triglyceride and total cholesterol. Four sons of a 72-year-old woman also underwent BMIPP scintigraphy. No BMIPP uptake was also observed in her 2nd son (49 years old) and his electrocardiogram showed QT prolongation. Since these rare findings indicating no myocardial BMIPP uptake were seen in a family, we suspected that a hereditary myocardial metabolic abnormality accounted for them.

3-Iodobenzylguanidine↗
PubMed1996

Clinical experience with conservative surgery for vaginal endodermal sinus tumor.

Two cases of vaginal endodermal sinus tumor (EST), a rare pediatric malignancy, were managed with conservative surgery followed by adjuvant chemotherapy. The first case involved a 9-month-old girl with EST of the vagina, who was treated with a partial vaginectomy and VAC regimen (vincristine, actinomycin D, cyclophosphamide) during a 2-year period. The serum alpha-fetoprotein (AFP) level returned to normal after excision of the tumor, and it remained normal throughout the treatment period. There was no evidence of disease 30 months after diagnosis. The second case involved an 8-month-old girl with EST of the vagina, who was treated with local excision of the mass through a vaginotomy. The VAC regimen was administered, but the serum AFP level remained elevated. A follow-up abdominopelvic computed tomography scan, taken 4 months after the operation, showed local recurrence of the tumor. The VAC regimen was then changed to a BEP regimen (bleomycin, etoposide, cisplatin). The serum AFP level returned to normal after 2 courses of the new regimen, and no tumor was visible on the follow-up magnetic resonance imaging study. For vaginal EST, primary conservative surgery and adjuvant chemotherapy are attractive measures to preserve both reproductive and sexual function. The extent of conservative surgery requires at least a partial vaginectomy. Simple tumor excision may not be adequate to achieve cure or to prevent local recurrence, even with adjuvant chemotherapy. The serum AFP level is useful for diagnosing and monitoring vaginal EST in the infant.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

An unusual case of monozygotic epigastric heteropagus twinning.

Epigastric heteropagus refers to unequal and asymmetric conjoined twins in which the dependent component (parasite) is smaller and usually attached to the epigastrium of the dominant component (autosite). Epigastric heteropagus is a very rare type of conjoined twins. It is generally assumed that conjoined twins represent a form of monozygotic twinning, but there has been no confirmation of this monozygotic hypothesis. Epigastric heteropagus twins differ in several ways from symmetrical conjoined twins. These include male preponderance, and no major connection of vessels, bowels, or bones. These significant characteristics suggest to the authors that the fusion of two fertilized ova and the atrophy of one fetus resulted in this interesting malformation. However, a DNA study indicated monozygotic origin in their case. The possible pathogenesis was ischemic atrophy of the body structure of the monozygotic conjoined twins at an early gestational age.

DNA↗
PubMed1996

201Tl and 99Tcm-human serum albumin for assessment of the effect of hypertensive treatment with angiotensin II infusion on tumour circulation.

The biodistribution of 201Tl and of 99Tcm-human serum albumin (99Tcm-HSA) was observed in tumour-bearing mice to investigate if tissue blood circulation could be evaluated in groups of mice infused with angiotensin II at a rate of 0.5 micrograms kg-1 min-1 (L) or 1 microgram kg-1 min-1 (H). Ten minutes after tracer injection, tumour uptake of 201Tl in the angiotensin II infused group showed a 2.20- and a 3.18-fold increase in the L and H groups, respectively, when compared to a group of mice infused with saline (P = 0.0478 and 0.0029, respectively). The effect of angiotensin II infusion on 201Tl uptake was minimal in normal organs. Decreased normal organ uptake of simultaneously injected 99Tcm-HSA in the L and H groups indicated the contraction of normal organ vessels, while increased tumour uptake of the tracer indicated mechanical dilatation of tumour vessels. We conclude that the effect of angiotensin II or other vasoactive agents can be non-invasively assessed by 201Tl and 99Tcm-HSA scintigraphy.

Angiotensin II↗
PubMed1996

Gamma/delta T lymphocytes in the BCG granulomatous lesions.

Recent studies in man and animal models have demonstrated that TCR-gamma delta-bearing T cells (gamma delta T cells) are activated by mycobacteria and accumulate in the sites of mycobacterial infection. Although the function of gamma delta T cells remains unclear, some data suggest a potential role for these cells in the granulomatous immune response. To address the presence of gamma delta T cells within the BCG granulomas, we have characterized the TCR phenotype of T-lymphocytes present in the BCG granulomatous lesion immunohistochemically using a monoclonal antibody to TCR delta 1 and others. Fairly large numbers of gamma delta T cells were located at the periphery of the BCG granulomas without necrosis and most of them also expressed CD8. However, gamma delta T cells were rarely present in the granulomas with central caseous necrosis, calcification and fibrotic changes. With these results, it might be speculated that the CD8+ gamma delta T lymphocytes participate in the BCG granuloma formation mainly in the early stage.

Female↗
PubMed1995

How important is the role of the internal anal sphincter in fecal continence? An experimental study in dogs.

It is a generalized concept that the internal anal sphincter (IAS) plays a significant role in fecal continence by generating high pressure in the anal canal at rest and relaxation during rectal distention. Agreement also exists on the importance of internal sphincter-saving anoplasty on anorectal malformations in establishing anal continence. Twelve dogs were divided into four groups. Group 1, a control group, was subjected to a perirectal dissection only. Group 2 underwent the same perirectal dissection plus a 2-cm resection of the anal canal. Group 3 underwent the perirectal dissection plus a 4-cm resection of the anal canal, and group 4 underwent perirectal dissection and transposition of the anus to the posterolateral portion of the voluntary muscle mass. Clinical continence was evaluated, and manometric results were compared with preoperative measurements. All dogs in groups 1, 2, and 3 were clinically continent without soiling except one in group 3, and also manometric results showed minimal change between preoperative and postoperative anal pressure profiles. The transposed anus of group 4 showed continuous fecal soiling. The anal resting pressure (ARP) was also decreased but still existed in this group. This experimental study showed that the IAS contributes to the anal resting tone. However, resection of the IAS did not completely interfere with fecal continence. The smooth muscle of pulled-through rectum seemed to partly take over the function of the IAS.

Anal Canal↗
PubMed1995

Transhiatal gastric transposition of a long gap esophageal atresia.

Transhiatal gastric transposition was performed in a long gap esophageal atresia without tracheoesophageal fistula. The patient was a 12 months old female infant with previous stamm-type gastrostomy. The stomach was mobilized preserving the right gastric artery, the right gastroepiploic artery and spleen. The proximal and distal blind pouches of esophagus were excised by transcervical and transhiatal route, respectively. The mobilized stomach was pulled up into the neck through esophageal hiatus and posterior mediastinal route. The esophagogastrostomy, the only one anastomosis of this procedure, was safely performed in the neck. There were neither anastomotic leak nor early anastomotic stricture. The oral feeding was quickly established. There was no clinical evidence of regurgitation, difficulty of gastric emptying, hoarseness or respiratory problem. The low morbidity combined with satisfactory functional result indicates that the transhiatal gastric transposition is a safe and easy alternative surgical procedure for esophageal replacement in long gap esophageal atresia.

Esophageal Atresia↗
PubMed1995

Long-term follow-up of gracilis muscle transposition in children.

Sixteen children of uncontrollable fecal incontinence have been treated with Pickrell's gracilis muscle transposition since 1983: 12 had an imperforate anuses with multiple corrective operative procedures and 4 had traumatic destructions of anal sphincters. We report a series of 11 cases whom we followed-up over a period of 0.8 to 10.5 years (mean; 5.6 years). Seven patients were evaluated by anorectal manometry. All patients except one who had left hemipelvectomy and permanent colostomy showed nearly normal continence during the follow-up period. There was no evidence of fibrosis in the transposed muscles and the tensions of the transposed muscles were well maintained. The voluntary contractions of the transposed muscles were well maintained and efficient in all cases. The general manometric parameters did not correlate well with the functional results; however, there was a strong correlation in the S/R ratio (maximum squeeze pressure/resting pressure) with the functional results. We believe that the good functional outcome of this procedure need not only the meticulous surgical technique but also the personal motivation and the compliance with physiotherapy. In conclusion, although the gracilis muscle transposition never results in normal continence, acceptable continence can be achieved in the selected patients.

Adolescent↗